Intensive care unit

Intensive care unit
ICU patients often require mechanical ventilation if they have lost the ability to breathe normally.

An intensive care unit (ICU), also known as an intensive therapy unit or intensive treatment unit (ITU) or critical care unit (CCU), is a special department of a hospital or health care facility that provides intensive treatment medicine.

Intensive care units cater to patients with severe and life-threatening illnesses and injuries, which require constant, close monitoring and support from specialist equipment and medications in order to ensure normal bodily functions. They are staffed by highly trained doctors and nurses who specialise in caring for critically ill patients. ICUs are also distinguished from normal hospital wards by a higher staff-to-patient ratio and access to advanced medical resources and equipment that is not routinely available elsewhere. Common conditions that are treated within ICUs include ARDS, trauma, multiple organ failure and sepsis.[1]

Patients may be transferred directly to an intensive care unit from an emergency department if required, or from a ward if they rapidly deteriorate, or immediately after surgery if the surgery is very invasive and the patient is at high risk of complications.[2]


In 1854, Florence Nightingale left for a Crimean War, where triage used to separate seriously wounded soldiers from the less-seriously wounded, was observed. Until recently, it was reported that Nightingale reduced mortality from 40% to 2% on the battlefield. Although this was not the case, her experiences during the war formed the foundation for her later discovery of the importance of sanitary conditions in hospitals, a critical component of intensive care. In 1950, anesthesiologist Peter Safar established the concept of "Advanced Support of Life", keeping patients sedated and ventilated in an intensive care environment. Safar is considered to be the first practitioner of intensive care medicine as a speciality. In response to a polio epidemic (where many patients required constant ventilation and surveillance), Bjørn Aage Ibsen established the first intensive care unit in Copenhagen in 1953.[3][4][5] The first application of this idea in the United States was in 1955 by Dr. William Mosenthal, a surgeon at the Dartmouth-Hitchcock Medical Center.[6] In the 1960s, the importance of cardiac arrhythmias as a source of morbidity and mortality in myocardial infarctions (heart attacks) was recognized. This led to the routine use of cardiac monitoring in ICUs, especially after heart attacks.[7]


ICU Nurse attending to a patient in Baghdad, Iraq.
ICU nurses monitoring patients from a central computer station. This allows for rapid intervention should a patient's condition deteriorate whilst a member of staff is not immediately at the bedside.
Nurses in a neonatal intensive care unit (NICU)

Hospitals may have ICUs that cater to a specific medical speciality or patient, such as those listed below:

Out of Hospital ICU

A specialized ambulance with the staff and equipment to provide on-scene Advanced Life Support resuscitation and intensive care during transport. In the Anglo American model of pre-hospital care MICUs are generally paramedic crewed. In the Franco German model MICU crews are usually a specialist nurse and doctor. Some systems use a mix of the two models.

Equipment and systems

Common equipment in an ICU includes mechanical ventilators to assist breathing through an endotracheal tube or a tracheostomy tube; cardiac monitors including those with telemetry; external pacemakers; defibrillators; dialysis equipment for renal problems; equipment for the constant monitoring of bodily functions; a web of intravenous lines, feeding tubes, nasogastric tubes, suction pumps, drains, and catheters; and a wide array of drugs to treat the primary condition(s) of hospitalization. Medically induced comas, analgesics, and induced sedation are common ICU tools needed and used to reduce pain and prevent secondary infections.

Quality of care

The available data suggests a relation between ICU volume and quality of care for mechanically ventilated patients.[9] After adjustment for severity of illnesses, demographic variables, and characteristics of different ICUs (including staffing by intensivists), higher ICU staffing was significantly associated with lower ICU and hospital mortality rates. A ratio of 2 patients to 1 nurse is recommended for a medical ICU, which contrasts to the ratio of 4:1 or 5:1 typically seen on medical floors. This varies from country to country, though; e.g., in Australia and the United Kingdom most ICUs are staffed on a 2:1 basis (for high-dependency patients who require closer monitoring or more intensive treatment than a hospital ward can offer) or on a 1:1 basis for patients requiring very intensive support and monitoring; for example, a patient on a mechanical ventilator with associated anaesthetics or sedation such as propofol, midazolam and use of strong analgesics such as morphine, fentanyl and/or remifentanil.

Operational logistics

In the United States, up to 20% of hospital beds can be labelled as intensive-care beds; in the United Kingdom, intensive care usually will comprise only up to 2% of total beds. This high disparity is attributed to admission of patients in the UK only when considered the most severely ill.[10]

Intensive care is an expensive healthcare service. A recent study conducted in the United States found, hospital stays that involved ICU services were 2.5 times more costly than other hospital stays.[11]

In the United Kingdom, the average cost of funding an intensive care unit is:[12]

Remote collaboration systems

Some hospitals have installed teleconferencing systems that allow doctors and nurses at a central facility (either in the same building, at a central location serving several local hospitals, or in rural locations another more urban facility) to collaborate with on-site staff and speak with patients (a form of telemedicine). This is variously called an eICU, virtual ICU, or tele-ICU. Remote staff typically have access to vital signs from live monitoring equipment, and to electronic health records so they can get a broader view of a patient's medical history. Often bedside and remote staff have met in person and may rotate responsibilities. Such systems allow hospitals to double-check that correct procedures are being followed for the patients most vulnerable to mistakes, and to use access expertise remotely to keep patients that would otherwise have to be transferred to a larger facility, and have demonstrated a significant decrease in mortality.[13][14][15][16]

See also


  1. [Existing Link doesn't Work: "What is Intensive Care?"] Check |url= value (help). London: Intensive Care Society. 2011. Retrieved 2013-05-25.
  2. Smith, S. E. (2013-03-24). "What is an ICU". wiseGEEK. Bronwyn Harris, ed. Sparks, Nevada: Conjecture Corporation. Retrieved 2012-06-15.
  3. Takrouri, M.S.M. (2004). "Intensive Care Unit". Internet Journal of Health. Sugar Land, Texas: Internet Scientific Publications. 3 (2). doi:10.5580/1c97. ISSN 1528-8315. OCLC 43535892. Retrieved 2007-08-25.
  4. Reisner-Sénélar, L. (2009), "Der dänische Anästhesist Björn Ibsen ein Pionier der Langzeitbeatmung über die oberen Luftwege", Doctoral Thesis (in German), Frankfurt am Main, Germany: Johann Wolfgang Goethe University, OCLC 600186486. Translation of introduction available here.
  5. Reisner-Sénélar, L. (2009). "The Danish anaesthesiologist Björn Ibsen a pioneer of long-term ventilation on the upper airways" (PDF).
  6. Grossman, D.C. (Spring 2004). "Vital Signs: Remembering Dr. William Mosenthal: A simple idea from a special surgeon". Dartmouth Medicine. Dartmouth College, Geisel School of Medicine. 28 (3). Retrieved 2007-04-10.
  7. "História da Terapia Intensiva" [Intensive Care History] (video in English linked to from website). Sociedade Brasileira de Terapia Intensiva (Brazilian Society of Critical Care) website English version. Produced by Tfran Ediçao de Imagens. Uploaded to YouTube by user: Thiago Francisco. 2008-06-06. External link in |work= (help)
  8. "Intensive Care Patients Experiences: High Dependency Units" (compiled patient testimonials),, Oxford, England: DIPEx, November 2012
  9. Kahn, J.M.; Goss, C.H.; Heagerty, P.J.; Kramer, A.A.; et al. (2006-07-06). "Hospital volume and the outcomes of mechanical ventilation". New England Journal of Medicine. 355 (1): 41–50. doi:10.1056/NEJMsa053993. PMID 16822995.
  10. Bennett, D.; Bion, J. (1999). "Organisation of intensive care". BMJ (Clinical research ed.). 318 (7196): 1468–70. doi:10.1136/bmj.318.7196.1468. PMC 1115845Freely accessible. PMID 10346777.
  11. Barrett ML, Smith MW, Elizhauser A, Honigman LS, Pines JM (December 2014). "Utilization of Intensive Care Services, 2011". HCUP Statistical Brief #185. Rockville, MD: Agency for Healthcare Research and Quality.
  12. Winterton, R. (2005-06-15), "Written Answers text: Trent Strategic Health Authority", Hansard - House of Commons Debates, Westminister, England: Stationery Office, Parliament, Volume 435, part 87, column 520W.
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